Cholera epidemic after increased civil conflict--Monrovia, Liberia, June-September 2003.

Since 1989, civil war in Liberia has resulted in the displacement of hundreds of thousands of persons. In June 2003, as rebel forces approached the capital city of Monrovia (2003 estimated population: one million), an estimated 300,000 internally displaced persons (IDPs) settled in private homes with family members, public buildings, and other sites. Because of fighting during June-July, the normal collection of health data by the Liberian Ministry of Health (MoH) was interrupted. In June, cases of cholera were confirmed by international nongovernment organizations. To estimate the magnitude of the outbreak, in August, the World Health Organization (WHO) conducted a retrospective review of data collected by health organizations during June--August 2003 but not reported to MoH. Additional data were collected from an emergency surveillance system that began operation on August 25. This report summarizes the results of that analysis, which indicated that as of September 22, a cholera epidemic was ongoing in Monrovia. During the week ending October 20, a total of 1,252 cases of suspected cholera were reported (WHO, MoH, unpublished data, 2003). As of November 12, the epidemic was continuing. The epidemic began in June and was associated temporally with increased fighting and the movement of IDPs. Because cholera transmission was probably attributable to an acute shortage of clean water, poor sanitation, and crowded living conditions, international and Liberian organizations attempted to supply IDP settlements with sufficient potable water and began chlorinating wells. To stop cholera transmission and avoid additional illness and death, further preventive measures are needed.